New HIV Incidence Shows Overall Stability, But Rising Rate among Youth and MSM

Thirty years after HIV/AIDS first appearedin the United States, the Centers for Disease Control and Prevention (CDC) have released their first multi-year estimates of new HIV incidence for the years 2006–2009. While the figures show overall new infections remaining at about 50,000 annually, new infections in men who have sex with men (MSM)—and, more specifically, young African American MSM—have seen dramatic increases over the four years. CDC officials feel that these numbers bring new cause for concern.[1]

Although the total number of annual diagnoses is far from its peak of 130,000 per year in the 1980s, the CDC feels that the number is still far too high; the U.S. infection rate hit the 50,000 level in 2000, indicating that new diagnoses of HIV have not decreased for over a decade.[2] Dr. Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the CDC, notes that 50,000 new infections every year is an “unacceptably high level” and warns that without new, innovative solutions “we’re likely to face an era of rising infection rates and higher health care costs for a preventable condition that already affects more than one million people in this country.”[3] Dr. Thomas Frieden, director of the CDC, notes that the agency is glad that the level of new infection is not increasing, but “it’s not good enough.”[4]

Furthermore, infection rates are increasing within some groups. Over the four years documented in the study, the incidence of new HIV infection in MSM ages 13–29 increased by 34 percent, indicating that this is the group most affected.[5] More particularly, new infections in young African American MSM increased 48 percent from 2006 to 2009. Although the roots of this effect are still being investigated, many possible causes have been discussed. There seems to be agreement that young black MSM are not engaging in behaviors any riskier than those of young, white MSM.[6] Instead, the CDC points to the stigma still surrounding HIV and MSM, noting that this shame results in a greater number of African American MSM not getting tested for HIV or seeking the health care they need; less testing thus leads to more unknown spreading of the virus.[7] Of this trend, Jonathan Mermin, MD, director of the CDC’s Division of HIV/AIDS Prevention, comments, “We cannot allow the health of a new generation of gay men to be lost to a preventable disease. It’s time to renew the focus on HIV among gay men and confront the homophobia and stigma that all too often accompany this disease.”[8]

Across the board, the effects of the epidemic are still disproportionately felt by communities of color. Of new HIV infections in 2009, the estimates show that 44 percent were among African Americans and 20 percent were among Hispanic Americans.[9] Additionally, the rates of infection in Hispanic and African American women were four and 15 times that of white women, respectively.[10] The CDC recognizes this gap and is looking to close it. Dr. Fenton notes that “HIV remains one of the most glaring health disparities in this country. . . . Individual risk behavior alone doesn’t account for the significant racial disparities in HIV. It is essential to understand the underlying factors that contribute to these disparities, such as poverty, discrimination and lack of access to health care.”[11]

The new estimates do show decreases in two areas. First, only 100 women a year infect their children through birth or breast-feeding, down from 1,300 infections in 1990. Second, infections from drug use have fallen 80 percent; this number may be due to a general drop in drug injection, which lessens the need to share needles.[12]

Nonetheless, the CDC estimates that 1.2 million people in the United States have HIV. Perhaps more daunting is the estimate that 20 percent of those people do not know they are infected.[13]